As the year draws to an end, I am proud to report 2018 was the Alliance’s most successful year financially. In 2018, the Alliance received payments for the work performed in MSSP for the year 2017 of over 5 million dollars. Likewise the projections for the first year of our Next Gen program are forecasting revenue in the 6 million dollar range. In addition, our success in the BPCI program continued to be very profitable to the Alliance with a multimillion-dollar revenue stream from this CMS program. Our work in the QuE program also saw significant savings which was shared with the hospital system, the Alliance and the physicians associated with these programs. Even our commercial value-based contracts yielded positive returns although they pale in comparison to the government programs.

At the same time, our quality committee has been redefined and energized with a renewed focus on improving quality of care and not just monitoring and checking off metrics. It is gratifying to discover financial gains can occur while simultaneously improving quality.

Moving forward, the potential to succeed in the CMS programs, particularly at the level we enjoyed in 2018 will be much more challenging. In the NextGen program, for year 2019, our comparison year shifts from 2014 to a hybrid of 2016-17, subsequently all the work accomplished over the past 4 years will no longer be as great an ally as it was in 2018. The BPCI program has been replaced with a second-generation program titled BPCI Advanced with more stringent goals for financial success.

This should not be construed as a “bait and switch” tactic from CMS, rather the bar being raised as the programs progress. The first years are meant to introduce an ACO to a new concept of reimbursement and enable them to get comfortable with the program. Then, similar to a pole-vaulter, once a level of achievement is achieved, higher level goals are set. Obviously, this process cannot go on in perpetuity, as there is only so much to be squeezed out of current health care costs. Presumably, the next phase will be some form of capitation for the entire network. But that is still several years from occurring.

We can succeed with the tighter margins placed upon our network. To do so, we have to learn to function as a network, not simply as physicians within a network. It must be incorporated in our daily thought processes as we care for patients, what treatment plan delivers best quality and efficiency. I encourage you to speak to your partners, your department peers and all your colleagues regarding how we can best practice medicine to meet the visions set forth by the Alliance. No one is more capable than the physicians of a particular domain to determine how to best practice efficient, high quality medicine. The challenge is upon us to take on this responsibility and continue the success we have achieved to date.

For the calendar year 2018, Mary Washington Health Alliance will distribute $1.5 million to physicians within the network in performance distribution. I suspect all of us would like to see this level of distribution continue in the future, if not rise. My New Year’s challenge to all of you is find how you can make this successful while continuing to improve the quality of care delivered.

Happy New Year!.

Tom Janus, DO